Rebel Heart and Emergencies at Sea

Practical Sailor profiled air ambulance rescue services in its March 2014 issue.

The story of the rescue of a sick 1-year-old girl, her parents, and toddler sister from aboard the boat Rebel Heart last week provoked a storm of controversy over whether ocean voyaging with young children is sensible. The Kaufman family of four was pulled from their boat about 900 miles off the coast of Mexico, when the youngest child, Lyra, 1, was covered in a rash and had a fever.

Although my wife, Theresa, and I made a conscious decision after 10 years of living aboard to move ashore to have children, I have known many cruisers who have raised their children aboard. In every case, their own lives and the lives of their children have been richer because of this experience.

What interested me most about the Rebel Heart story were the practical matters. Would it have been possible to treat this infant at sea? Should we be prepared for these types of emergencies—particularly those of us sailing with vulnerable crew, be they the young or the old. (See my recent column about the experiences of the crew aboard Corsair.) Like many cruisers I know, my most frightening experiences while cruising had nothing to do with storms or pirates, or all the imagined threats that landlubbers conjure up. They were health related—severe skin infections, venomous fish, dengue fever, debilitating gastrointestinal illnesses, you name it. Tropical paradises, people often forget, is rife with tropical diseases.

Telemedicine Trends

The March and April 2014 issues of Practical Sailor addressed a growing trend in health at sea, the use of telemedicine services to treat onboard illnesses remotely, and the growing number of private air-ambulance services to rescue people in remote places. Although it is unlikely that the family’s rescue would have gone differently had they subscribed to an air-ambulance service (none of the services we polled are equipped to manage such a complicated at-sea rescue), a subscription with one of the telemedicine services we profiled might have allowed the Kaufman’s to treat their daughter on board and keep their boat. (Ultimately, the U.S. Navy scuttled Rebel Heart, so it would not be a navigational hazard.)

One of the reasons that Theresa and I chose not to have and raise children aboard our boat were our own dicey experiences with illness in the tropics. (Our threadbare, vagabond lifestyle at the time raised other salient concerns, as Theresa put it—“I’m not giving birth in the forepeak!”) But if we had decided to cruise with young children, we would have likely avoided long passages and kept pediatric care within close reach. If we had decided to embark on longer passages such as the Kaufman’s into the Pacific, I would have likely invested in satcom equipment (as the Kaufman’s did) and subscribed to one of the telemedicine services offered today. But there are other, more affordable options.

Predeparture Planning

One of the biggest benefits of telemedical services is the pre-departure consultation, which ensures that you have pharmaceuticals and first-aid tools on board to treat the most likely ailments. You don’t have to be a subscriber to benefit from this pre-departure advice. It can be a one-time consultation.

This is the path we took before we set out. Before our own departure, we paid a private physician who specialized in tropical diseases to consult us on equipping our first-aid kit, which included several courses of antibiotics of different types. He and my father, who is a physician, also helped us build a library of books on board for treating illnesses, and provided specific guidance on the use of the medications we had. For non-prescription supplies, we looked at various commercial kits and built our own based on their contents. Our December 2008 issue profiled Practical Sailor's favorite pre-packaged medical kits for voyagers.

Fortunately, when the most serious illness struck Theresa (dengue fever), we were near an island clinic, but even then, the only thing that the doctors could do was diagnose the problem and prescribe an anti-nausea pill that we did not stock (but soon did). Ultimately, I was the one who treated her using our own medicines to control fever and ensure that she remained hydrated.

The bottom line is that when you do decide to embark on a more prolonged cruise, you will almost surely find yourself in a situation where you have to be your own doctor, if only temporarily. Like storms and squalls and reefs, illness is something we should try to prepare for as much as possible. Though it is reassuring that such rescues at sea are possible in worst-case situations like the Kaufman’s, it would be wrong (and potentially fatal) to embark on any cruise without making our own health and the health of our crew a top priority.

As an update to this story, the Kaufman's did have a satellite phone on board, and, apparently, the medication required to treat their sick child. However, it appears the satellite phone did not work. The Kaufman's filed a lawsuit against the service provider earlier this year.

Editor's note: For those inclined to donate, a fundraising site has been set up to help the Kaufman family.

Comments (11)

"A man has got to know his limitations." Words to live by from Dirty Harry.

In my 50+ years I've completed numerous sailing and mountaineering adventures, some with children and some with elderly guests. There are a few things I have always tried to keep clear in my mind:
* Don't take anyone who cannot understand what they are getting into. That includes adults who lack the expereince judge, but not all children.
* Don't pretend that small children will gain from the expereince; if they are less than 6 they won't even rememeber, and less than 8 will lack the ability to relate important parts to life. You need to wait or at least recognize you are doing this for YOU.
* Young, healthy people, unless there have been health problems in the family, are not able to understand the importance of quick access. And while I might tell my 30 year old buddy to suck-it-up, I cannot say that to a small child or elderly person; they can die when they barely seem ill.

Though I believe in my sole they are good parents, life tought them a lesson that may be valueable later and that should be valueable to many would-be cruisers; the price of adventure can be high, and everyone must be responsible to judge if they are ready to pay.

I wonder what is the cost of insuring against ocean rescue? I doubt the world will somehow require it, but I'd hate to think that any potential rescuer might be dissuaded by the cost. Perhaps everyone at sea should carry ocean rescue insurance as a community benefit, to make sure that rescuers don't become reluctant.

I can think of many tales of surviving illness at sea: Chichester and Slocum, for instance. But even more, it seems to me that there are far too many anecdotes of failure of steering, self-steering, or power. Perhaps approaching 100%, i.e. I have experienced them, and everyone else seems to have, too. Rig failure looms higher in most people's minds as a risk. Perhaps we should focus on really decreasing these most common disasters. A big step would be the collection of detailed statistics, so we know what really fails most often.

One thing that is going to come back to bite the cruising community in the butt, is all the calling for help. This is sure to bring new regulations or expense to us all. After last years Salty Dog, the Coast Guard posted a notice warning that we sailors should be better prepared. It seems every year more people are lifted off boats, some of which end up floating around the ocean for weeks. Maybe it is just too easy to call for help these days. Surely, this will created more controversy and more regulations. A few come to mind already, like New Zealand's boat inspections before you can leave, or Chile's requirement that you have hull insurance, due likely to their Navy having to rescue too many yachts. The very thing that is so appealing to many, when it comes to sailing, is getting away from it all. That use to require you accepted that total self reliance was required, as it was not so easy to get help. All that has changed with EPIRBs and Sat phones. Now it seems people dial "911" a lot. I'm not saying people should not use the SARs systems, but realize every time someone does, they are inviting the world's opinions as to their situation. All this attention is sure to bring unwanted consequences. Our cherished freedom to come and go, and do as we wish at sea, will go away. Life afloat will become, as life ashore. That is very sad.

Given the way the mainstream media has approached this story, I can see how what I wrote could be construed as suggesting the Kaufmann's made a wrong choice. Or that my advocating that you carry a well-stocked medical kit be interpreted as saying that we should prepare for every contingency. I am not passing judgment on their actions (which I know very little about), and certainly not their decision to sail with children. The last line was more an expression of concern that future novice voyagers--based on the outcome of this event--will not put the amount of thought and effort into assessing and anticipating their crew's health problems. Or that they may be ignorant of the health risks, which, as I pointed out, are different (not necessarily more dangerous) from those we have at home. The easy access to a "Help" button does not absolve the captain of same responsibilities they have had for centuries over their crew's health. As a parent, I can't imagine the Kaufman's did not put the health of their children as a priority--but I do worry that others might see the event as evidence that help will always be there in future emergencies, so why should they bother taking the care to consult with a doctor or thoroughly research what medicines they might need for specific locations. Technology and SAR capabilities are not a substitute for self-sufficiency, which I am advocating here. I see tele-medicine not as another crutch to lean on, but a way to expand our abilities to treat onboard illnesses ourselves. I had also hoped to raise cruising sailors' awareness of the expanding number of free or relatively inexpensive resources available to them (including several helpful Practical Sailor reports), so that they can have the ability to treat themselves in an emergency.

As a retired Navy officer myself, I have to say that the family did not consider casualty situations enough, and that is what most people should be criticizing. Even if both kids had been well, the failure of the engine and helm would still cause them to call for help. They did fine there. The real issue is that the kids are not able to fend for themselves in any way. Both require constant attention. Both would have required immediate attention from their parents in any crisis. I would not take a child to sea until I feel safe knowing he can jump overboard or move to the dinghy while I try to put out the fire or stop the flooding. In those two emergencies, and others, the father and mother would have attended to the two helpless kids and could not fight the emergency, putting them all in the water when saving the boat may have been preventable. People who cannot fend for themselves become major distractions immediately and divert the entire crew.

We live in San Diego and were sailing yesterday with a group of very experienced folks including a retired Navy Captain. About the only thing we could all agree on was that we did not have enough information to make an informed call on this issue. Life is full of risks and overcoming adversity makes us better human beings. Would I personally take off on a multi-thousand mile trip with toddlers, no. That does not mean this family was negligent. I respectfully suggest we all hold off making a judgement call till more information becomes available. They return on board the USS Vandegrift FFG-48 sometime today. I am curious what type of reception they'll get here in San Diego from the media...

I am not suggesting one recklessly avoid reducing risk. What i am saying is that risk is part of our everyday life and we can walk around encapsulated in a bubble or live our lives taking appropriate precaution. But the firestorm of criticism about this couple is way beyond reasonable second guessing. No one has proven, nor is it any of their business, to show that the Kaufamans did anything negligent. I guess they could have had a larger boat, maybe an on-board physician, maybe a 'million' maybes. As for the comments about "And if they so fearless and so smart, why did they rely on "big mama". How ludicrous can one be...so on one hand they are being condemned for taking this voyage with a young child but when they do the appropriate thing by calling for rescue, whether it be the US Coast Guard or from a passing freighter you mock them. Sorry but i don't buy this crap, where we need warning labels on every product or activity.

I am very thankful that they are all safe. That being said, I am more interested in what went wrong with the boat. Why did it lose power and steerage? It is pointless to argue over whether or not they should have taken their kids on this voyage. Does anyone know what failed on the boat? What can we learn from it so that we can be prepared should any of us face that in the future.

Lou, you need to rethink your reaction. Sensibly reducing risk is not a liberal or conservative thing (although psychologists would consider it a trait characteristic of conservatives). The fact is that young children, because of their inexperienced immune systems, are more susceptible to infectious disease than adults, and generally have less capacity to survive extended bouts of fever and dehydration from lower body mass. That is why the greatest advances in longevity during the last century relate to declines in infant/child mortality. Long passages and tropical exploits with infants are therefore exceptionally risky. Americans have become far too oblivious to risk, to the point of irresponsibility. When one ventures into a high-risk situation, knowingly or otherwise, their actions affect far beyond their immediate group. Consider the unnecessary risk to rescue personnel involved in their evacuation, let alone the cost which is likely hundreds of thousands of dollars.

Lou V.,
The only difference between one year old getting sick and "elderly person, or any person for that matter!" is that one year old can't talk, can't care fore herself and can't tolerate any discomfort. So, it has to be constantly taken care of. It means that in any case of even minor disaster the Kaufmans have more than just emergency at their hands, but two small helpless kids who takes all their attention away.
Now, if you look at probability of "shit happens" with small kids, that probability is 10 times higher than with grownup. To 5-6 year kid you can explain what to do and how to behave, and he/she will follow you. Not to 1 and 3 y.o. Not to mention that immune system of small kids are not up to a task to defend against all kind of diseases you can get in tropics or just in any other continents.

There is no need to live "maybe i should just lock myself away in my room" lifestyle with small kids. But, you there are plenty of cruising can be done along a coast of North and South America that would not involve satellite calls to US Navy and use of so many resources when "shit happens" with your child.

So, yes, Kaufmans made very poor choice and what Darrell wrote is not "nothing but BS", it is common sense. And if they so fearless and so smart, why did they rely on "big mama" - (US government, that you, liberal hater, so much dislike)? Isn't because they knew that probability of disaster is high, but show their immature rebellion they still wanted to go?

Ah come off it! I am so sick of the media and holy-than-thou liberals second guessing and even condemning the Kaufmans. Some morons are going as far as to suggest that they are not fit to have children and the kids should be taken away! All this from a society that finds it perfectly fashionable to abort a child even in later states of a pregnancy. Or farm the kids out to day care or violent prone public schools or plop them in front of inane television programs that do nothing but pump sexual and violent content into the brains 24/7. Would the outcome have been any different and the condemnation any less virulent IF the person on board, who became ill was an elderly person, or any person for that matter! Shit happens and these people, by all accounts were not neophytes nor bad parents. There is not one of us, who has set out on a sea voyage who have not had second thoughts and a feeling of dread or foreboding prior to our voyage. Yet because Mrs. Kaufamn shared those thoughts in a blog, her inner fears, which we ALL feel, are being used against her. Great Darrell, you and your wife chose not to travel with children, that is your prerogative and your decision, but your fears and suggestion that they made the wrong choice is nothing but BS. Life is full of risks and trying to account for every contingency, "oh should have had a stand by medical account" or "maybe we should travel with our very own ER physician" or "maybe i should just lock myself away in my room" makes life not worth living. Give these people a break and stop playing Monday morning quarterback. Far too many families, for eons have set out in boats, of all types and have returned safe, sound and far better for the experience.